ORTHODONTICS BLOG

You walk up to the checkout line at the grocery store, and your cashier - along with all the rest of the people in the grocery store - have masks covering their nose and mouth. You have scanned all the open lanes and chose one because the cashier is a youthful (mid 20 year old) gentleman with a recent haircut who is tall enough to see over the stacks of gum and gift cards, and you can see his head moving back and forth quickly, and his eyes focused on typing in those skew numbers with intense focus. Bagging for him is a cleanly dressed young lady under 20 years old, deeply concentrated on the items she is slinging into one bag or another. Her posture is held high and her eyes are full of energy.

Whether you realize it or not, your mind has already tried to make little assumptions about your cashier based on his or her height, hair color, cleanliness, posture, clothes, and eyes.

For instance, you can tell by looking at someone, approximately how old they are, what mood they might be in, and approximately what their physical capabilities are. In today's politically correct climate, this type of cursory judgement sounds wrong, but it is actually a very important and efficient way to gather a lot of information in a short amount of time - even if that information may prove to be slightly inaccurate with further investigation.

For instance, if you were in an emergency situation and needed to call on someone to help you lift an injured friend into a car so they could be driven to help, you would look for the biggest, strongest looking person nearby, who would hopefully speak the same language you do, and have the physical capacity to help you lift the weight of a full grown human being without injuring themselves or your friend.

The saying: "A picture is worth a thousand words," is absolutely true when it comes to gathering information on a day to day basis. That is why we gravitate toward pictures when looking through online dating profiles, and even better... videos! Why do you think TikTok is perhaps more popular than facebook now... (and I know that last sentence is going to date this blog because I'm sure there is another social media venue that's probably more trendy than TikTok now... but you get the jist).

Our reliance on our most evolutionarily advanced sense - sight - is so ingrained in our subconscious thought that most of us probably actually take it for granted.

Covid-19 has undoubtedly changed the way we look and see the world these days. For better or for worse, we have all been exposed to different social and economical challenges in the past year, and will need to evolve with the times or get left behind. There are a lot of unmeasurable side effects to all the local public health orders that have been instituted over the last 15 months, and some are more obvious than others.

For instance, the concept of quarantining... For some people that became a form of voluntary "solitary confinement". There were people who voluntarily put themselves in a situation that formerly would have been reserved for only the most misbehaved social deviants in the prison system as a form of punishment. We now see that isolation can lead to mental health problems and cult behaviors, but it wasn't something that we paid attention to before Covid.

In my particular industry, I want to draw attention to the effect that mask mandates have made and what things we need to be aware of if we are going to continue to wear masks long-term. Please don't get me wrong, this is not a politically driven tirade about being anti-mask. I am protected by masks every day, and I think we can all safely say that they have their physical benefits and protective properties. I am not a materials scientist, epidemiologist, or medical researcher, and I am not going to speak on whether masks work or not. I just want to shed a little light on my corner of the mask world... which is the diagnosis and treatment of dental abnormalities and dental/facial development.

Form follows function. This sentence is used in dentistry and medicine to describe the fact that many of our body parts seem to have been engineered to fit their function. The topographical anatomy of our teeth (when arranged appropriately) actually gear together similar to the gears on a bike or car. The hard and soft parts of our jaw joints are designed to lubricate and move smoothly to allow for strength and efficiency when the muscles activate and compress different densities of food, until they are turned into the uniform and soft bolus that we eventually swallow. So when we change how our bodies normally function, typically there is a resulting change in the "form" or shape that our bodies take.

For instance, children with deviated septums, obstructive adenoids, or chronic allergies, who only breathe through their mouths, end up with much longer and narrower faces, and could potentially grow into an adult body that never really does any nasal breathing because the nose was never really used as a child. If you do a simple google search you will see many examples of this trend.

Many times, these children also appear tired (with dark circles under their eyes) and can also be more prone to ADHD because they may be getting very fragmented sleep if they are not getting adequate air flow during their sleeping hours (when their brain is supposed to be consolidating memories and generating new connections). When children (or adults) wear masks for prolonged periods of time, we often find ourselves breathing through our mouths instead of through our noses, and this can have detrimental side effects over the long term. Just read bestselling author James Nestor's book "Breath: The new science of a lost art".

As you might imagine, masks also make it a lot harder for me to diagnose mouth breathing or other detrimental oral habits during our initial exams, because for the majority of a child's appointment, their face is covered and I have no idea what it looks like under the mask. Of course the child will take off their mask for a short period of time for me to do my exam, however most times, their parents will encourage them to immediately put their masks back on once the physical examination is completed. Then if I bring up the subject of oral habits, most parents are unsure of what position their child typically holds their mouth in, and the child typically immediately becomes aware of their mouth and alters their behavior or posture, so accurate diagnosis of poor oral posture is almost impossible when masks are required.

So the take home from this, is that if you are a parent or an individual with a mouth breathing habit, I encourage you to pay attention to your jaw posture or your child's resting jaw posture. Your typical dental professionals are a bit handicapped for the time being, (almost like trying to do their work with one hand tied behind their backs) so please be on the lookout for poor oral habits in the people you care about! Proper resting tongue posture should be suctioned up to the roof of the mouth (towards the back) as if you were about to make a clicking sound with your tongue. Without significant allergies, you should be breathing adequately through your nose with lips closed. Teeth can either be touching or a millimeter apart, but tongue and lips should be sealed. If we all do our part to watch out for each other and our loved ones, we can hopefully escape from this altered state of normal with the least amount of physical and emotional scarring and look forward to a bright future ahead.

Be safe and stay healthy out there!

What can you expect as a patient of Yamashiro Orthodontics in the coming months?

As the Coronavirus continues to plague our society, the questions lingering in our mind are centered around: “What can we do to help prevent the spread of infection?”. As time passes by, we are introduced to more facts and information regarding COVID-19 and the way it is spread and what makes it so dangerous.

Last week our office attended a webinar by presenter, Dr. Leslie Fang, who took all the information that has been provided from around the world and created a summary of what we know now (well as of last week).

Dr. Leslie Fang has a PhD in physiology and biophysics from the University of Illinois. Following this, he received his medical degree from Harvard Medical School. He is a Chief Resident of Massachusetts General Hospital and still practices internal medicine and nephrology. He has received the John and Catherine Gallagher endowed chair in Clinical Excellence. He still teaches at Harvard and offers books of dental and medicine. He has also received seven teaching awards from Harvard and nine teaching awards from Massachusetts General.

In the paragraphs following, we will summarize what Dr. Leslie Fang presented from his extensive research regarding what medicine is doing for us right now to help combat COVID-19.

Dr. Fang reports that every scientist, researcher, and doctor around the world has pretty much stopped all other tests, trials, and research that does not involve COVID-19. There is no other research being done, the world has come to a full halt to try and solve the issues surrounding COVID-19.

In general, it takes about 10 years for vaccines to be introduced to the public in large quantities. When the world was threatened by Ebola, we were able to find a vaccine in as few as five years. This time, with the collaboration nationally and internationally, we are working towards finding a vaccine within 12 to 18 months. This is breakneck, pandemic speeds.

You may be asking, “Well how are they able to do this when it took us 5 years to figure out Ebola?” Due to the transmission of COVID-19, we are in a pandemic. Its weekly death rate has surpassed that of heart disease, the former number one weekly killer.

At this point, they are basically doing lab, animal, human testing and mass production all “in parallel” (or “at the same time”), to try and find a solution. Usually when working on a vaccine, they do animal testing and then phase it out to a small sample size of humans, and then to a larger sample size and then start mass producing it. Right now, they are doing all of this at the same time. They are doing testing in labs, and on small samples of humans, and mass producing what they believe will work so that when they find something that does work it can be sent straight to the masses.

So now you may be asking, “Isn’t that a bit dangerous to run these tests parallel to each other?” Yes and no. Right now, COVID-19 is running rampant with more people ending up on ventilators, and ECMO’s, and some not ever recovering. (If you google what an ECMO does it seems pretty intense!) It takes about two weeks to twenty days in the hospital for a patient to either recover or be pronounced deceased. That means for two weeks, a single patient is taking up a bed or room in a hospital and taking up the time of providers, nurses, and other hospital staff and taking up hospital resources. Some of the drugs that they are testing have been on the market for a very long time so they have the general idea of how these work, they have been approved by the FDA and now they are just working on tweaking it to try to find a treatment.

At the same time you have probably already heard what our local community is doing to help prepare for the possible surge of COVID-19 patients showing up at the hospitals.

So now you are probably asking, “What do these tests mean for me?” and “What about prevention so we can go back to work?”.

On January 11th, 2020, the CDC released the gene sequence of COVID-19. This gene sequence was then used to start creating antibodies. Antibodies are what your body naturally creates to detect and fight off foreign particles in your body, but synthetic ones that pharmaceutical companies can make, basically act like secret intelligence for our immune system, warning it of what’s to come. Antibodies were used to help increase the survival rate during Ebola; and they were able to create an antibody that doubled the survival rate before there was a vaccine. In addition, antibodies are the bridge to a vaccine.

• On February 8th, 2020, Moderna, a biotechnology company, created their first clinical batch, 25 days after the gene sequence was released.
• By February 24th, 2020 they shipped this first batch to the National Institute of Health (NIH), 42 days after the gene sequence was released.
• By March 16th, 2020 they were in Phase I of human trials, 60 days after the gene sequence was released.

As Dr. Fang put it, “This is breakneck speeds” at which we are finding the information needed to create a vaccine. Moderna is hoping that by Fall of 2020, they will have a vaccine in place for some of the population to use. At this point in time, it will be reserved for the population on the frontline such as medical staff who are being exposed daily. Dr. Fauci, the doctor in charge of the National Institute of Allergy and Infectious Disease and medical advisor to the White House, is hoping that in 12-18 months we will have a vaccine that is commercially available. Now remember, it usually takes 10 years and with Ebola we did it in 5 years. This vaccine is coming along at a rate that nobody has ever seen before.

Now it is important to remember that the death rate will probably continue to climb and lag behind the rate of new cases for another 20 days as this is approximately how long a patient is in the hospital before they are either discharged or die. Right now there are a lot of conspiracy theories out, about how the effect of this virus has been completely overblown and the amount of deaths is not as high as they predicted. But let’s face it, without more data, we can’t tell if the reduced death rate is because of social distancing, or because it’s a hoax. And the price you pay for being wrong is higher if you assume it was a conspiracy. So we, as an office, will not take sides, but will expect to continue social distancing during the summer and hopefully be done by October or November... but of course, things are changing on a daily basis so we are also expecting to be wrong, and to need to be “nimble” for the next year or so. Now different cities and even states will have to look at their own rates to be able to decide when they are able to open. New York City will not be the same as New Jersey which will be completely different than Kentucky.

Below is a model of what was happening in the United States as far as hot spots of infection last week:

You are also probably saying, “Well the cases have plateaued, and they are going down…”. Correct, they have, but coming down is still 30,000 cases a day (nationwide) and remember, the death totals are 20 days behind! So it is important to not become complacent. We must continue the way we are to help keep these numbers coming down and help keep our hospitals from being overwhelmed.

Governor Polis’ statewide stay at home order is set to expire at the end of the week and he mentioned that it would change to a “Safer at home” guideline. He can still change his mind, but now you are probably wondering: “What is the world going to be like getting back to work and ending quarantine?” and “What is Yamashiro Orthodontics going to do to help keep me safe while still moving forward with my orthodontic treatment?” (Remember this is still just an orthodontist’s office blog, so take all of the above information for what it’s worth)

We are following the CDC and OSHA guidelines to keep our workers and employees safe. We have always followed these guidelines including wearing masks, gloves, eyewear, proper sterilization of equipment and patient chairs between each patient. But now they are advising wearing Personal Protective Equipment (PPE) all day and we are now going to have the proper tools to cover our hair and shoes in the coming months. As we have done before, we are spraying and wiping down surfaces between and after every patient. In addition you may notice some of the following:

• Staff Screening: Our staff is screened daily, and our temperatures are taken in the morning and before returning from lunch, to help catch any early symptoms that might arise.
• Patient Screening: We will also be pre-screening all our patients over the phone before their appointments as well as taking everyone’s temperature upon arrival. You may notice our new screening station when you walk in.
• Personal Protective Equipment: Our staff has been issued one N95 mask each to help keep patients and staff protected but at the same time participate in the responsible sourcing and distribution of PPE (personal protective equipment) in the community.
And all the staff have been trained on proper donning and doffing of PPE.
• Air Purifiers: We have installed four Air Purifiers with new HEPA filters and internal UVC components that will be running all day to trap and kill virus particles in the air.
• No Spectators: Although we usually love to have you all where we can chat and discuss how awesome your smiles are, we have been advised to no longer allow spectators in the patient treatment areas (to reduce exposure to possible airborne contaminants and continue social distancing as much as possible).
• No Congregating: You will notice that we have removed all our wonderful magazines and have also removed some chairs in the reception area to promote social distancing practices. Since our cell phones have somewhat replaced the need for magazine’s anyway… we are also encouraging the use of our virtual waiting room! :) This means that as a patient, you can stay in your own car and text us at 303-443-3774 when you arrive. Then our awesome front desk will let you know when we are ready for you to come in. If you biked or took the bus here, or just don’t want to stay outside, we are happy to have you, but we want to let you know that we will require you to wear a mask if you decide to stay in the waiting area.

  

• No Clutter: We have cleaned and removed all clutter in the office to make surfaces easier to clean, and we are spraying wiping down handles and hard surfaces throughout the office every few hours.
• Reuse When Possible: We will be using UV light and/or hydrogen peroxide to sterilize and reuse hard to find PPE
• Social Distancing: As we are all tied together in this wonderful community, we as a team have committed to continue to practice our social distancing at home during our personal time, as well as what we can do in the workplace.
• Follow what works: Dental offices in Korea have been having a lot of success continuing regular treatments without incident by using ultra low volume foggers to disinfect and reduce aerosolized particles in the air and all hard to reach surfaces 2 to 3 times a day. So once our shipment arrives, we will be making our own hypochlorous acid disinfectant and using a fogger throughout the day to keep everyone safe.

Things will definitely be different around here, and we thank you all for your patience and support during this transition. We wrote this blog to help bring about understanding and let you know that we are doing everything we can to ensure your safety. Even though we have been closed, the team here at Yamashiro Orthodontics has been working behind the scenes to be able to take care of you and get your treatments back on track as soon as possible. Please stay safe out there!

Resources:
DOCS Education 2020 “COVID-19 The Eye of the Storm” presented by Dr. Leslie Fang

With the increasing popularity of 3D printing and "Do It Yourself" shows that highlight how easy it is to take something that was normally professionally done, and get it done for fractions of the cost yourself, many people have been wondering about finding their own ways to straighten their teeth. There are also companies that now market at home orthodontics via facebook and hulu that report they can save you thousands of dollars by having you do the treatment yourself in the comfort of your own home... but what's the catch?

There is no doubt that orthodontics seems simple and straight-forward on the outside. Being able to straighten your teeth with seemingly simple products like Invisalign (a removable series of clear retainers) makes it seem like anyone could fabricate and design their own aligners, or at least send in a model of their teeth to have a company mail them trays that will align their teeth and what could go wrong?

What most people don't know, and what these "mail order orthodontic" companies don't tell you, is that moving your teeth is actually a bit harmful to your bone and gums. Orthodontics actually works, by using pressure (from the braces or Invisalign trays) to cut off the blood supply to the bone on part of your tooth. This then signals the bone on that side of your tooth to remodel and thus let the tooth move through the softened bone. Too much pressure, in the wrong direction can actually push your tooth out of the bone and cause it to fall out of your mouth! (Think... slow motion extraction) This does not happen immediately and can actually happen months after you are already done with your treatment.

You might think... "Well if something bad was happening to my tooth I think I would notice that..." Well, you might, or you might not. Because your teeth are already a bit tender from being moved (which is normal) it's hard to detect whether it's being moved too much or just enough unless you have a trained professional monitoring your case. Also, if you got lucky and happened to notice that something was wrong... do you know what to do to fix it? If you do, then you might want to start a university, because right now, even dental professionals don't have a good, predictable, and comfortable way to put back a tooth that has been extracted. (Believe me, if we did, then dental implants wouldn't be a multi-million dollar industry) In other words... once the damage is done, it can be irreversible. And if you get lucky and the damage you do is something that we can reverse... you better believe that the treatment to reverse the damage is probably more expensive than the money you saved trying to do your own orthodontics. (Ask anyone who has had a gum graft)

Long story longer... I'm all for DIY projects so you get to know the value of what other people do for a living, but when it comes to things that you only have one of (hope diamond, mona lisa)... things that have high damage potential (plumbing and electrical)... or things that don't grow back (eyes, nerves, tendons, muscle, teeth... ), let the professionals handle it if possible.

For more information see this article published by the American Association of Orthodontists

Form follows function, and few people realize that when you improve the look of your teeth, you are also improving their functionality as well as their longevity.

A study conducted by Invisalign and published by PR Newswire said

"Americans perceive those with straight teeth to be 45% more likely than those with crooked teeth to get a job when competing with someone who has a similar skill set and experience. They are also seen as 58% more likely to be successful, as well as 58% more likely to be wealthy."

Original Article

According to Mercedes White from Deseret News:

"But income isn’t the only thing impacted by the appearance of a person’s teeth. Researchers have noted pronounced negative associations with crooked, discolored and decaying teeth. Approximately 40 percent of respondents to a 2012 study by Kelton Research said that they would not date someone with crooked teeth. And about 73 percent said that people with straight teeth are more trustworthy."

"Public health officials are also quick to point out that dental issues are medical issues"

We also have many aesthetic options while you are in your orthodontic treatment; like clear brackets and Invisalign.

Just because you can use your teeth pretty well now doesn't mean that they will stay that way forever either. Many people don't realize they have bite or functional issues because they perceive them to be "just cosmetic" and they do not realize the detrimental side effects it could be having on their longevity.

"The ADA recognizes the use of fluoride and community water fluoridation as safe and effective in preventing tooth decay for both children and adults."

"If you have diabetes, you are at greater risk of developing some oral health problems than are people who do not have diabetes. Diabetes increases your risk of developing periodontal (severe gum) diseases. Because diabetes lowers resistance to infection, you also are more prone to developing oral infections. Controlling blood glucose (blood sugar) levels can reduce the risk of these effects."

All toothpastes with the ADA Seal of Acceptance must contain fluoride.

In addition to fluoride, toothpastes may contain active ingredients to help in ways such as lessening tooth sensitivity, whitening teeth, reducing gingivitis or tartar build-up, or preventing enamel erosion or bad breath.

Flavoring agents that cause or contribute to tooth decay (e.g., sugar) may not be contained in any ADA-Accepted toothpaste.

A product earns the ADA Seal of Acceptance by providing scientific evidence that demonstrates the safety and efficacy, which the ADA Council on Scientific Affairs carefully evaluates according to objective requirements.